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Barriers to Identifying Learning Disabilities: A Qualitative Study of Clinicians and Educators

  • Lauren A. Stone
    Correspondence
    Address correspondence to Lauren A. Stone, AB, Yale University Child Study Center, 230 S Frontage Road, New Haven, CT, 06510.
    Affiliations
    Child Study Center (LA Stone, L Benoit, and A Martin), Yale School of Medicine, New Haven, Conn
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  • Author Footnotes
    1 Permanent address: Inserm, CESP, DevPsy Team, Maison de Solenn, Hôpital Cochin AP-HP, 97 Bd de Port-Royal, 75014, Paris, France.
    Laelia Benoit
    Footnotes
    1 Permanent address: Inserm, CESP, DevPsy Team, Maison de Solenn, Hôpital Cochin AP-HP, 97 Bd de Port-Royal, 75014, Paris, France.
    Affiliations
    Child Study Center (LA Stone, L Benoit, and A Martin), Yale School of Medicine, New Haven, Conn
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  • Andrés Martin
    Affiliations
    Child Study Center (LA Stone, L Benoit, and A Martin), Yale School of Medicine, New Haven, Conn
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  • Janet Hafler
    Affiliations
    Department of Pediatrics (J Hafler), Yale School of Medicine, New Haven, Conn
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  • Author Footnotes
    1 Permanent address: Inserm, CESP, DevPsy Team, Maison de Solenn, Hôpital Cochin AP-HP, 97 Bd de Port-Royal, 75014, Paris, France.
Published:December 26, 2022DOI:https://doi.org/10.1016/j.acap.2022.12.008

      Abstract

      Objective

      The estimated prevalence of learning disabilities (LDs) is nearly 8% of all children. Fewer than 5% of all children are diagnosed in public schools, jeopardizing remediation. We aimed to identify barriers affecting front-line child-facing professionals in detecting LDs in school-aged children.

      Methods

      We conducted a qualitative study with individual interviews of 40 professionals from different areas of the United States identified through theoretical sampling (20 educators, 10 pediatricians, and 10 child mental health clinicians). Clinicians represented academic and community settings, and educators represented public, private, and charter schools. Twenty had expertise in assessing LDs; 20 were generalists without specific training. We also endeavored to maximize representation across age, gender, race and ethnicity, and location. We analyzed transcripts utilizing grounded theory and identified themes reflecting barriers to detection.

      Results

      Themes and sub-themes included: 1) areas requiring improved professional education (misconceptions that may hinder detection, confounding factors that may mask LDs, and need for increasing engagement of parents or guardians in identifying LDs) and 2) systemic barriers (time constraints that limited professionals’ ability to advocate for children and to delve into their emotional experiences, inconsistent guidelines across institutions and inconsistent perceptions of professional responsibility for detection, and confusion surrounding screening tools and lack of screening by some professionals in the absence of overt problems).

      Conclusions

      Clinicians and other child-facing professionals may benefit from augmented training in screening and identification and enhanced evidence-based and institutional guidance. These efforts could increase efficiency and perceived responsibility for recognition and improve earlier detection.

      Keywords

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